Applying Corrigan's progressive model of self-stigma to people with depression

Nele Cornelia Göpfert; Steffen Conrad von Heydendorff; Harald Dreßing; Josef Bailer

doi:10.1371/journal.pone.0224418

Applying Corrigan's progressive model of self-stigma to people with depression

PLoS One. 2019 Oct 29;14(10):e0224418. doi: 10.1371/journal.pone.0224418. eCollection 2019.

Authors

Nele Cornelia Göpfert¹, Steffen Conrad von Heydendorff², Harald Dreßing³, Josef Bailer¹

Affiliations

¹ Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim / University Heidelberg, Mannheim, Germany.
² Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim / University Heidelberg, Mannheim, Germany.
³ Department of Forensic Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim / University Heidelberg, Mannheim, Germany.

Abstract

Background: The progressive model of self-stigma describes four stages of internalizing stereotypes of mental illness: stereotype awareness, personal agreement, self-concurrence, and harm to self (i.e., self-esteem). Successive stages are postulated to be the most highly related. Endorsement is presumed to decrease by stage. The model has been supported in most but not all elements in various studies. The procedural character has not yet been investigated in one integrative model. The aim of this study was to test the progressive model of self-stigma in three respects: I) successive stages have the strongest associations, II) endorsements decrease with each stage, and III) the procedural character can be represented by one serial mediation model.

Methods: A cross-sectional computer-based survey was conducted in two samples of patients with depression; one online sample (NA = 550; only self-report) and one clinical face-to-face sample (NB = 180; screening by treatment staff). The inclusion criteria were, age of 18-70 years, sufficient cognitive abilities and German language skills. IBM SPSS statistics 24 was used for Cronbach's alphas, descriptive statistics, Spearman correlations, and Mann-Whitney-U tests. The PROCESS procedure for SPSS Version 3.00 was used for mediation analyses.

Results: The results support the progressive model of self-stigma in people with depression in most respects: Endorsements for stereotype awareness were higher than for personal agreement and self-concurrence, and no relevant difference was found between personal agreement and self-concurrence. Successive stages had the strongest associations, with the exception of the association between stereotype awareness and self-esteem, which was higher than the association between stereotype awareness and personal agreement and self-concurrence. The association between stereotype awareness and self-esteem was mediated via personal agreement and self-concurrence.

Conclusion: The progressive model of self-stigma offers a theoretical foundation for the process research of self-stigma. Longitudinal research may investigate predictive effects and whether different stages of self-stigma require specific consideration in their prediction, consequences, and potential interventions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Depression / psychology*
Depressive Disorder / psychology
Female
Humans
Interview, Psychological
Male
Middle Aged
Models, Psychological
Self Concept
Shame
Social Stigma*
Surveys and Questionnaires

Grants and funding

We acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding program Open Access Publishing, by the Baden-Württemberg Ministry of Science, Research and the Arts and by Ruprecht-Karls-Universität Heidelberg. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.